WSHIMA
WSHIMA – Case 1: Emergency departmentED COURSE & MEDICAL DECISION MAKING: 20 year old Caucasian female, G2P0A2 - with known IUFD at 14 weeks 5 days gestational pregnancy based on ABD US at outside hospital, presents with bleeding.This pt's prior medical records at the outside hospital were reviewed and contributed to ED medical evaluation.DDX: miscarriage, appendicitis, diverticulitis, pancreatitis, cholecystitis, pyelonephritis, SBO, pneumonia, chronic pelvic pain, dysmenorrhea,UTI, PID, STD, fibroids, ovarian cyst, endometriosis, endometrial neoplasm, ovarian neoplasm, ectopic pregnancy Workup included CMP, CBC, RH/ABO, Serum HCG, UA, LipaseProvided IVF, Morphine 4mg IV, and per OB recommendation Toradol 30mg IV and clindamycin 900 mg IVMDM: Well appearing, Nontoxic, NAD, VSS, afebrile, RA sats 98-100%.Exam not convincing for gross trauma, AMS, or resp distress. Labs reviewed and remarkable for: Serum pregnancy 869, WBCs 10.51, hemoglobin 10.8, hematocrit 33. Rest of labs unremarkable.ABO/RH: A positive - no indication for Rhogram. Greatly appreciate OB evaluation. Failed intrauterine pregnancy with no heartbeat today based on bedside limited ABD US. Consistent with outside hospital. US. OB discussed several options with patient for management of miscarriage. Patient strongly desired definitive surgical management. Reassessment: pt continues to report pain even after IV pain meds. Pt remained hemodynamically stable without any acute events. Continued NPOPlan: Transferred to OR for D&C. Pt states understanding and agreeable to plan. DISPOSITION/PLAN: Final disposition: Admit to med/surg bed. Admitting Service: OB. IMPRESSION/DIAGNOSIS: Intrauterine fetal demiseMiscarriage ................
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